Reduction of experimental diabetic vascular leakage and pericyte apoptosis in mice by delivery of αA-crystallin with a recombinant adenovirus

AIMS/HYPOTHESIS

The study aimed to evaluate the efficacy of recombinant adenovirus expressing αA-crystallin (Ad-αAc-Gfp) in reducing pericyte loss within retinal vasculature in early diabetes.

METHODS

Diabetes was induced by streptozotocin injection into C57BL/6 mice. Ad-αAc-Gfp was delivered by intravitreous injection to the right eyes of mice 2 weeks before induction of diabetes. Vascular leakage was determined by fluorescent angiography, Evans Blue leakage assay and leucocyte adhesion test. Production of αA-crystallin was analysed by immunoblotting and double immunostaining and pericyte loss was analysed by pericyte count.

RESULTS

Vessel leakage and pericyte loss were observed in the streptozotocin-induced diabetic retina. Decreased abundance of αA-crystallin in retinas 2 and 6 months after the induction of diabetes was confirmed by two-dimensional electrophoretic analysis, immunoblotting and RT-PCR. Double immunofluorescence staining for αA-crystallin and NG2 chondroitin sulphate proteoglycan revealed that αA-crystallin was predominantly produced in the retinal pericyte and that the number of αA-crystallin-producing pericytes decreased in the diabetic retina. Retinal infection with Ad-αAc-Gfp led to decreased pericyte loss and vascular leakage compared with control.

CONCLUSIONS/INTERPRETATION

Intravitreal delivery of Ad-αAc-Gfp protects against vascular leakage in the streptozotocin-induced model of diabetes. This effect is associated with the inhibition of diabetic retinal pericyte loss in early diabetes, suggesting that αA-crystallin has a role in preventing the pathogenesis of early diabetic retinopathy.

Migration of cytotoxic lymphocytes in cell cycle permits local MHC I-dependent control of division at sites of viral infection

Virus-specific cytotoxic CD8⁺ T cells are in cell cycle as they transit from lymphoid tissues to sites of infection.

After virus infection, cytotoxic T lymphocytes (CTLs) divide rapidly to eradicate the pathogen and prevent the establishment of persistence. The magnitude of an antiviral CTL response is thought to be controlled by the initiation of a cell cycle program within lymphoid tissues. However, it is presently not known whether this division program proceeds during migration or is influenced locally at sites of viral infection. We demonstrate that antiviral CTLs remain in cell cycle while transiting to infected tissues. Up to one third of virus-specific CTLs within blood were found to be in cell cycle after infection with lymphocytic choriomeningitis virus or vesicular stomatitis virus. Using two-photon microscopy, we found that effector CTL divided rapidly upon arrest in the virus-infected central nervous system as well as in meningeal blood vessels. We also observed that MHC I–dependent interactions, but not costimulation, influenced the division program by advancing effector CTL through stages of the cell cycle. These results demonstrate that CTLs are poised to divide in transit and that their numbers can be influenced locally at the site of infection through interactions with cells displaying cognate antigen.

Optimizing multiphoton fluorescence microscopy light collection from living tissue by noncontact total emission detection (epiTED)

A benefit of multiphoton fluorescence microscopy is the inherent optical sectioning that occurs during excitation at the diffraction-limited spot. The scanned collection of fluorescence emission is incoherent; that is, no real image needs to be formed on the detector plane. The nearly isotropic emission of fluorescence excited at the focal spot allows for new detection schemes that efficiently funnel all attainable photons to detector(s). We previously showed [Combs, C.A., et al. (2007) Optimization of multiphoton excitation microscopy by total emission detection using a parabolic light reflector. J. Microsc. 228, 330-337] that parabolic mirrors and condensers could be combined to collect the totality of solid angle around the excitation spot for tissue blocks, leading to ∼8-fold signal gain. Using a similar approach, we have developed an in vivo total emission detection (epiTED) instrument modified to make noncontact images from outside of living tissue. Simulations suggest that a ∼4-fold enhancement may be possible (much larger with lower NA objectives than the 0.95 NA used here) with this approach, depending on objective characteristics, imaging depth and the characteristics of the sample being imaged. In our initial prototype, 2-fold improvements were demonstrated in the mouse brain and skeletal muscle as well as the rat kidney, using a variety of fluorophores and no compromise of spatial resolution. These results show this epiTED prototype effectively doubles emission signal in vivo; thus, it will maintain the image signal-to-noise ratio at two times the scan rate or enable full scan rate at approximately 30% reduced laser power (to minimize photo-damage).

Caudal epidural block in children: comparison of needle insertion parallel with caudal canal versus conventional two-step technique

This study compared the technique of inserting the needle for caudal epidural blockade in a single pass parallel to the caudal canal versus the conventional technique of approaching the caudal canal with the needle at a steeper angle. Seventy-five patients, aged 0 to 72 months, scheduled for urological surgery were prospectively enrolled in this study. Patients were randomly divided into two groups: a conventional method group (caudal block performed with conventional needle insertion, n=40) and a new method group (needle inserted into the skin at an angle of 200 and into the caudal space without redirection, n=35). Two anaesthetists (A, B) performed the caudal blocks. For anaesthetist A, the mean time required (standard deviation) to perform needle insertion in the conventional method group was 2.2 (0.8) minutes and in the new method group 1.1 (0.7) minutes (P = 0.03). For anaesthetist B the mean time (standard deviation) to perform needle insertion in the conventional method group was 2.1 (1.1) minutes and in the new method group 1.3 (0.8) minutes (P = 0.04). Successful block was considered as first pass placement of the needle in the caudal canal confirmed (after placement) by ultrasound imaging, and the absence of a bloody tap. Subcutaneous placement of the needle after the first attempt occurred in two cases in the conventional method group and three cases in the new method group. Bloody tap occurred in four cases, all in the conventional method group and none in the new method group. When required, the second pass was successful in all cases.

A genome-wide microarray analysis reveals anti-inflammatory target genes of paeonol in macrophages

OBJECTIVE

Paeony root has long been used for its anti-inflammatory effects. In this study, the effects of albiflorin, paeoniflorin, and paeonol, compounds from paeony root, on gene expression profiles were examined in macrophages challenged with the inflammation inducer lipopolysaccharide (LPS).

METHODS

The RAW264.7 macrophages were treated with LPS in the presence or absence of albiflorin, paeoniflorin, or paeonol. Global mRNA expression levels were detected by using an oligonucleotide microarray platform covering the mouse whole genome.

RESULTS

Treatment with LPS caused expression level changes in 1,270 genes by 2 folds or more. Paeonol attenuated the induction level of 355 LPS-responsive genes. Classification of the genes targeted by paeonol according to the Panther group analysis revealed 20 biological processes, 24 molecular functions, and 22 signaling pathways. The Panther signaling pathways highly affected by paeonol included the 'inflammation mediated by chemokine and cytokine signaling', 'interleukin signaling', and 'Toll receptor signaling'.

CONCLUSION

Our results demonstrate that paeonol has extensive inhibitory effects on the regulation of inflammation associated gene expression by LPS in macrophages. In addition, the predominant effect of paeonol among the tested compounds suggests that paeonol may be a major ingredient for the anti-inflammatory effect of paeony root.

Lymphocytic choriomeningitis infection of the central nervous system

Viral infection of the central nervous system (CNS) can result in a multitude of responses including pathology, persistence or immune clearance. Lymphocytic choriomeningitis virus (LCMV) is a powerful model system to explore these potential outcomes of CNS infection due to the diversity of responses that can be achieved after viral inoculation. Several factors including tropism, timing, dose and variant of LCMV in combination with the development or suppression of the corresponding immune response dictates whether lethal meningitis, chronic infection or clearance of LCMV in the CNS will occur. Importantly, the functionality and positioning of the LCMV-specific CD8+ T cell response are critical in directing the subsequent outcome of CNS LCMV infection. Although a basic understanding of LCMV and immune interactions in the brain exists, the molecular machinery that shapes the balance between pathogenesis and clearance in the LCMV-infected CNS remains to be elucidated. This review covers the various outcomes of LCMV infection in the CNS and what is currently known about the impact of the virus itself versus the immune response in the development of disease or clearance.

An antibiotic-responsive mouse model of fulminant ulcerative colitis

BACKGROUND

The constellation of human inflammatory bowel disease (IBD) includes ulcerative colitis and Crohn's disease, which both display a wide spectrum in the severity of pathology. One theory is that multiple genetic hits to the host immune system may contribute to the susceptibility and severity of IBD. However, experimental proof of this concept is still lacking. Several genetic mouse models that each recapitulate some aspects of human IBD have utilized a single gene defect to induce colitis. However, none have produced pathology clearly distinguishable as either ulcerative colitis or Crohn's disease, in part because none of them reproduce the most severe forms of disease that are observed in human patients. This lack of severe IBD models has posed a challenge for research into pathogenic mechanisms and development of new treatments. We hypothesized that multiple genetic hits to the regulatory machinery that normally inhibits immune activation in the intestine would generate more severe, reproducible pathology that would mimic either ulcerative colitis or Crohn's disease.

METHODS AND FINDINGS

We generated a novel mouse line (dnKO) that possessed defects in both TGFbetaRII and IL-10R2 signaling. These mice rapidly and reproducibly developed a disease resembling fulminant human ulcerative colitis that was quite distinct from the much longer and more variable course of pathology observed previously in mice possessing only single defects. Pathogenesis was driven by uncontrolled production of proinflammatory cytokines resulting in large part from T cell activation. The disease process could be significantly ameliorated by administration of antibodies against IFNgamma and TNFalpha and was completely inhibited by a combination of broad-spectrum antibiotics.

CONCLUSIONS

Here, we develop to our knowledge the first mouse model of fulminant ulcerative colitis by combining multiple genetic hits in immune regulation and demonstrate that the resulting disease is sensitive to both anticytokine therapy and broad-spectrum antibiotics. These findings indicated the IL-10 and TGFbeta pathways synergize to inhibit microbially induced production of proinflammatory cytokines, including IFNgamma and TNFalpha, which are known to play a role in the pathogenesis of human ulcerative colitis. Our findings also provide evidence that broad-spectrum antibiotics may have an application in the treatment of patients with ulcerative colitis. This model system will be useful in the future to explore the microbial factors that induce immune activation and characterize how these interactions produce disease.

Triamcinolone acetonide protects the rat retina from STZ-induced acute inflammation and early vascular leakage

Streptozotocin (STZ) has been commonly used to induce in vivo and in vitro hyperglycemic diabetes and its toxicity leads to inflammation and vascular injury. Triamcinolone acetonide (TA), as an anti-angiogenic/anti-inflammatory drug, is clinically used to improve the visual acuity in neovascular and edematous ocular diseases. The aim of this study was to investigate the effect of TA on early inflammation and vascular leakage in the retina of STZ-induced hyperglycemic rats. Hyperglycemia was induced in 8-week-old male Sprague-Dawley (SD) rats by a single intraperitoneal injection of STZ (65 mg/kg); only rats with blood glucose levels >13.9 mmol/l 1 day after STZ injection were included in STZ-hyperglycemic group. Sex- and age-matched SD rats injected with buffer were used as the control group. One day before STZ and buffer injection, 2 microl TA (4 mg/ml in saline) and 2 microl saline were intravitreal-injected into the right and the left eyes of rats, respectively. Retinal vascular leakage was measured using the Evans-blue method. Changes in pro-inflammatory target genes, such as tumor necrotic factor (TNF)-alpha, intracellular adhesion molecule (ICAM)-1, and vascular endothelial growth factor (VEGF) were assessed by immunoblottings, immunostaining, and ELISA analyses. Vascular hyperleakage and up-regulation of most pro-inflammatory genes peaked within a few days after STZ injection and had recovered. However, these changes were blocked by TA pretreatment. Our data suggest that TA controls STZ-induced early vascular leakage and temporary pro-inflammatory signals in the rat retina.

Protein kinase C delta regulates anti-apoptotic alphaB-crystallin in the retina of type 2 diabetes

We investigated the relationship between phosphorylation of alphaB-crystallin (alphaBC) and retinal apoptosis in type 2 diabetes. The retinas of male Otsuka Long-Evans Tokushima fatty (OLETF) rats at 24 and 35 weeks were used as an animal model for type 2 diabetes and sex- and age-matched Long-Evans Tokushima Otsuka (LETO) rats were used as controls. In the retinas of 35-week OLETF rats, the interaction between alphaBC and protein kinase C delta (PKC delta) among the PKC isozymes, alphaBC phosphorylation at Ser45 (S45p-alphaBC), TUNEL-positive apoptotic ganglion cells, several apoptotic signs, and co-localization of S45p-alphaBC and TUNEL significantly increased as compared with other groups while the alphaBC-Bax interaction greatly decreased. These changes were abolished by rottlerin treatment, a highly specific PKC delta inhibitor. These results suggest that PKC delta is involved in regulation of anti-apoptotic function of alphaBC in the retina of type 2 diabetes.

Triamcinolone suppresses retinal vascular pathology via a potent interruption of proinflammatory signal-regulated activation of VEGF during a relative hypoxia

We examined the effect of triamcinolone acetonide (TA), a corticosteroid, on the relationship between vascular pathophysiology and vascular endothelial growth factor (VEGF) activation in the retina of a rat model of oxygen-induced retinopathy (OIR). OIR was induced by exposure of hyperoxia (80% oxygen) to Sprague-Dawley (SD) rats from P2 to P14 and then returned to normoxic conditions. TA was intravitreal-injected once into the right eye of OIR rats at P15. Effects of TA on vascular pathophysiology or changes of various genes in response to hypoxia and/or proinflammation under hypoxic retina were assessed by the Evans-blue method, fluorescein isothiocyanate-dextran (FITC-D) infusion, immunoblotting, and ELIZA. TA not only reduced retinal neovascularization and vascular leakage in the OIR-rat retina, but also blocked the induction of hypoxia-response proinflammatory genes before it negatively controlled VEGF activation. These findings suggest a potential that TA suppresses retinal neovascular pathophysiology via proinflammation-mediated activation of VEGF during hypoxia.

Neuronavigation-Assisted Surgery for Distal Anterior Cerebral Artery Aneurysm

OBJECTIVE

We present our experience with the neuronavigation system as used for surgery of distal anterior cerebral artery (DACA) aneurysm.

METHODS

Between 2001 and 2004, 12 patients with a DACA aneurysm were consecutively treated with direct clipping assisted by the neuronavigation system. We used the BrainLAB Vector Vision neuronavigation system (BrainLAB, Heimstetten, Germany). Seven out of 12 patients presented with subarachnoid hemorrhage. Aneurysms were located at distal A2 in 10 patients and distal A3 in two patients. The size of the aneurysms ranged from 3-10 mm.

RESULTS

There were no procedure-related complications or technical problems during application of the neuronavigation system. The registration accuracy ranged from 0.5-1.5 mm (mean: 0.88 mm). The neuronavigation system provided real-time presentation of the DACA and the aneurysm, and allowed for identification of the DACA aneurysm in all patients. No surgical complications developed, and all 12 patients had a good recovery after direct clipping.

CONCLUSION

Although current neuronavigation systems are not available for all intracranial aneurysms, we believe that the DACA aneurysm is a good candidate for its use. The additional benefits of a small craniotomy and precise intraoperative orientation during surgery result in a minimally invasive aneurysm procedure.

Neuronavigation-Assisted Surgery for Distal Anterior Cerebral Artery Aneurysm

OBJECTIVE

We present our experience with the neuronavigation system used for surgery of distal anterior cerebral artery (DACA) aneurysms.

METHODS

Between 2001 and 2004, 12 patients with a DACA aneurysm were consecutively treated with direct clipping assisted by the neuronavigation system. We used the BrainLAB Vector Vision2 neuronavigation system (BrainLAB, Heimstetten, Germany). Seven out of 12 patients presented with subarachnoid hemorrhage. Aneurysms were located at distal A2 in 10 patients and distal A3 in two patients. The size of the aneurysms ranged from 3 to 10 mm.

RESULTS

There were no procedure-related complications or technical problems during application of the neuronavigation system. The registration accuracy ranged from 0.5 to 1.5 mm (mean: 0.88). The neuronavigation system provided real-time presentation of the DACA aneurysm, and allowed for identification of the DACA aneurysm in all patients. No surgical complications developed, and all 12 patients had a good recovery after direct clipping.

CONCLUSION

Although current neuronavigation systems are not available for all intracranial aneurysms, we believe that the DACA aneurysm is a good candidate for its use. The additional benefits of a small craniotomy and precise intraoperative orientation during surgery result in a minimally invasive aneurysm procedure.

Efficacy of moxibustion after rolling correction in dairy cows with abomasal displacement

This study was performed to assess the efficacy of moxibustion after rolling correction in dairy cows with abomasal displacement (AD). The experimental group comprised 86 Holstein cows with left displacement of the abomasum (LDA) and right displacement of the abomasum (RDA), with a mean age of 3.8 with AD during a 2-year period. The cows were rolled for correction of AD. After the rolling procedure, moxibustion was conducted on six acupoints once a day during the course of treatment. After repositioning the abomasums, the bilateral points of BL-20, BL-21 and BL-26 were then stimulated. During the follow-up of 1 week, 67 (93.1%) of 72 LDA and 12 (85.7%) of 14 RDA cows were released as cured after moxibustion. In conclusion, moxibustion effectively treats AD following rolling correction in dairy cows.

A new diterpenoid alkaloid from Aconitum jaluense

A new diterpenoid alkaloid, jaluenine (1), has been isolated from the roots of Aconitum jaluense. The structure of jaluenine was determined by spectroscopic methods including two dimensional NMR (1H-1H COSY, HMQC, HMBC, NOESY).

Are Your Arteries Older Than Your Age?

PURPOSE

To determine the effect of age and atherosclerotic risk factors on the carotid intima-media layer thickness and morphology characteristics.

PATIENTS AND METHODS

Three groups of subjects were included in the study: Individuals with atherosclerotic risk factors including a family history of CHD, hypertension, hyperlipidemia, diabetes, and/or smoking (group A, n=180), age- and sex-matched healthy subjects without risk factors (group B, n=60) and a group of significantly younger volunteers (group C, n=25). The carotid artery was imaged longitudinally with B-mode ultrasound. Intima media thickness (IMT) was measured in the common (CCA) and internal carotid (ICA) arteries. Surface irregularity and continuity of the intima-media layer (IML) were assessed by high definition imaging. Echogenicity of the wall was quantified using Adobe Photoshop. The presence of calcium deposits was recorded. The double line wall pattern seen in young healthy people was used as a control to assess patterns and texture of the carotid IML. Fifteen subjects had their measurements repeated for intraobserver variability.

RESULTS

IMT measurements were reproducible in both the CCA and ICA (coefficient of variation 6% and 9%). IMT increased linearly with age (adjusted R(2)=0.72, p<0.0001), which was also an independent risk factor for increased IMT. All the risk factors had a significant association with increased IMT. In the lowest (third) decade the wall/blood interface was smooth and the double line was visualized with an echolucent center. With increased age and number of risk factors present, the wall/blood interface became more irregular (p<0.01), the double line was distorted (p<0.01) and the IML was more echogenic (p<0.01). The increase in IMT and the changes in the echogenicity of the IML were more pronounced in the ICA.

CONCLUSIONS

Age is an independent risk factor for increased IMT. Atherosclerotic risk factors are associated with the age-related changes seen in the IML. Such changes are also seen in younger asymptomatic volunteers with risk factors indicating that their arteries are older than their age.

Antiobese and hypolipidemic effects of platycodin saponins in diet-induced obese rats: evidences for lipase inhibition and calorie intake restriction

OBJECTIVE

To investigate how and to what extent platycodin saponin (PS) from Platycodi Radix exerts a favorable influence on obesity and hyperlipidemia.

DESIGN

Sprague-Dawley rats were fed with a high fat (HF) diet for 4 weeks and then the animals were treated with 35 or 70 mg / kg of PS for another 4 weeks. Changes in body weight and daily calorie intake were measured regularly during the experimental period and the degree of linear correlation for the above two variables was further analyzed. The in vitro lipase inhibition of each PS compound and the in vivo fecal lipid excretion were examined in hope of revealing their relationship. The concentrations of hepatic triglyceride and cholesterol in serum.

RESULTS

The body weight reduction (13+/-4% vs HF control, P<0.05) by PS administration was highly correlated to the food intake restriction (Pearson's linear coefficient r=0.752, P<0.005). The in vitro inhibition of lipase by each isolated compound and mixture of PS were virtually identical. Consequently, the fecal TG excretion was increased by 2.1-3.2 folds depending on the dose of PS. The serum TG and LDL-cholesterol concentrations were decreased without noticeable changes in HDL-cholesterol levels. Concomitantly, the contents of the hepatic TG, cholesterol, and the liver surface fat pads were decreased in ubiquity, but no noticeable biochemical abnormalities or histological tissue damages were observed.

CONCLUSIONS

The administration of PS produced profound effects on the control of obesity and lipid metabolism, which resulted in LDL-cholesterol reduction. PS also caused a remarkable reduction in calorie intake, which was highly correlated to the body weight loss. These results suggest that PS has a greater role in anti-obesity, hypolipidemia, and liver protection than previously thought. Hence, PS could be a potential therapeutic alternative in the treatment of obesity and hyperlipidemia.

Expression of 14-3-3 zeta and interaction with protein kinase C in the rat retina in early diabetes

AIMS/HYPOTHESIS

The present study aimed to investigate the expression levels of and the relationship between 14-3-3 zeta and protein kinase C (PKC) in the retina of early diabetes.

METHODS

Changes in the expression levels of, and interaction between, 14-3-3 zeta and PKC were investigated by Northern and Western blot analyses, immunoprecipitation and double immunostaining in the retina of diabetic rats after 6 weeks of diabetes. PKC activity was examined using a PKC assay.

RESULTS

In the diabetic retina, the molecular levels of 14-3-3 zeta were reduced, while those of PKC beta and zeta were increased. Direct interaction between 14-3-3 zeta and PKC was markedly decreased in the retina after 6 weeks of diabetes, while PKC activity was increased.

CONCLUSIONS/INTERPRETATION

These findings show that a reduction in 14-3-3 zeta can induce PKC activation, suggesting that this is a main cause of visual dysfunction in the retina during diabetes.

Priming in the presence of IL-10 results in direct enhancement of CD8+ T cell primary responses and inhibition of secondary responses

Although IL-10 acts as an inhibitory cytokine for APC and CD4(+) T cell function, its effects on CD8(+) T cells are unclear. Additionally, little is known about whether initial priming in the presence of IL-10 can have long-lasting effects and influence subsequent CD8(+) T cell responses that occur in the absence of the cytokine. In the present study, we clarified the role of IL-10 during primary responses and examined whether exposure to IL-10 during initial priming of CD8(+) T cells impacted secondary responses. To determine the effect of IL-10 on Ag-specific T cell responses, peptide-pulsed IL-10R2(-/-) splenic dendritic cells were used to prime T cells from OT-I CD8(+) TCR transgenic mice. During the primary response, the presence of IL-10 resulted in enhancement of CD8(+) T cell numbers without detectable alterations in the kinetics or percentage of cells that underwent proliferation. A modest increase in survival, not attributable to Bcl-2 or Bcl-x(L), was also observed with IL-10 treatment. Other parameters of CD8(+) T cell function, including IL-2, IFN-gamma, TNF-alpha, and granzyme production, were unaltered. In contrast, initial exposure to IL-10 during the primary response resulted in decreased OT-I expansion during secondary stimulation. This was accompanied by lowered IL-2 levels and reduced percentages of proliferating BrdU(+) cells and OT-I cells that were CD25(high). IFN-gamma, TNF-alpha, and granzyme production were unaltered. These data suggest that initial exposure of CD8(+) T cells to IL-10 may be temporarily stimulatory; however, programming of the cells may be altered, resulting in diminished overall responses.

Dysplastic nodules in liver cirrhosis: detection with triple phase helical dynamic CT

The purpose of this study was to determine the sensitivity of triple phase helical dynamic CT for detecting dysplastic nodules in patients with liver cirrhosis. 76 dysplastic nodules were confirmed by histopathological examination of the liver specimens after surgical resection in 21 patients or after explantation of the whole liver in 20 patients. Triple phase helical dynamic CT including arterial, portal venous and delayed phases was performed as a pre-operative evaluation for hepatocellular carcinoma. Two readers retrospectively evaluated the images. The presence of dysplastic nodules was determined by one-to-one correlation of the CT images and the pathological results in terms of the anatomical location and size of each nodule. Helical dynamic triple phase CT depicted eight of 76 dysplastic nodules (10%): five of 35 high grade dysplastic nodules (14%) and three of 41 low grade dysplastic nodules (7%). Triple phase helical dynamic CT is insensitive for detection of dysplastic nodules in cirrhotic livers.

Neuronavigation-Guided Endoscopic Surgery for Pineal Tumors with Hydrocephalus

We have applied the neuronavigation system to endoscopic biopsy and third ventriculostomy in the management of patients with a pineal tumor with hydrocephalus. With the guidance of neuronavigation, the two optimal sites of burr hole and trajectories were planned preoperatively, and the advancing endoscopic device was monitored in real time during the procedure. In our five patients, the diameters of the tumors were 2-3 cm, and the mean systemic accuracy of registration with neuronavigation was 1.2 mm. The biopsy and third ventriculostomy were performed successfully via the respective optimal burr hole and the trajectory determined using preoperative neuronavigation. There were no procedure-related complications, and none of the patients needed another procedure for CSF diversion during the follow-up periods. We present our technique which includes the application of the neuronavigation system to the biopsy and third ventriculostomy in pineal tumor with associated hydrocephalus. This technique can be performed using a simple rigid endoscope via the determined optimal entries and trajectories. The optimal preoperative planning and the intraoperative guidance by neuronavigation are thought to be able to give more chances to minimize the brain injury related to movements or deviation of endoscopic device.

Sapheno-femoral Junction Reflux in Patients with a Normal Saphenous Trunk

OBJECTIVE

To determine the patterns and clinical importance of saphenofemoral junction (SFJ) reflux in patients with chronic venous disease (CVD) and a normal great saphenous vein (GSV) trunk.

METHODS

Fifteen hundred consecutive patients were examined using duplex ultrasound (DU) in three centres. Patients with reflux involving the SFJ and/or its tributaries only were included and its prevalence and patterns were studied. Patients with GSV trunk reflux or in any other veins were excluded. The SFJ diameter was categorised as normal, dilated or varicose. The results of surgery were evaluated by DU in 42 patients 1 year after the procedure.

RESULTS

SFJ area incompetence with a competent GSV trunk occurred in 8.8% of limbs. It was significantly more common in CEAP class 2, 13.6% compared to class 3, 8.2% (p=0.03), class 1, 2.7%, class 4, 4.4% and classes 5 and 6 together, 1.5% (p<0.001 for all). The SFJ had a normal diameter in 21%, dilated in 62% and varicose in 17%. Reflux was seen in 39% of limbs with a normal SFJ diameter, in 85% of those with a dilated SFJ and in all varicose SFJs. Of the 42 operated limbs, 27 had ligation and division of the SFJ and tributary phlebectomies. Fifteen had tributary phlebectomies only, leaving the SFJ intact. At one-year follow-up, SFJ area reflux was found in six limbs (14.3%), involving the SFJ alone in 1, a main tributary in 1 and 4 small tributaries. No reflux was found in the GSV trunk. All but two of the 42 patients were satisfied with the results.

CONCLUSIONS

SFJ reflux with tributary involvement and sparing of the GSV trunk occurs in 8.8% of CVD patients. Such reflux is found in the entire spectrum of CVD, but it is more common in class 2. Local surgery with or without SFJ ligation has very good results at 1 year. DU scanning prior to treatment is important in all patients so that the intact GSV can be spared.

Antimicrobial and cytotoxic activity of 18 prenylated flavonoids isolated from medicinal plants: Morus alba L., Morus mongolica Schneider, Broussnetia papyrifera (L.) Vent, Sophora flavescens Ait and Echinosophora koreensis Nakai

Antimicrobial activity of the 18 prenylated flavonoids, which were purified from five different medicinal plants, was evaluated by determination of MIC using the broth microdilution methods against four bacterial and two fungal microorganisms (Candida albicans, Saccaromyces cerevisiae, Escherichia coli, Salmonella typhimurium, Staphylococcus epidermis and S. aureus). Papyriflavonol A, kuraridin, sophoraflavanone D and sophoraisoflavanone A exhibited a good antifungal activity with strong antibacterial activity. Kuwanon C, mulberrofuran G, albanol B, kenusanone A and sophoraflavanone G showed strong antibacterial activity with 5-30 microg/ml of MICs. Morusin, sanggenon B and D, kazinol B, kurarinone, kenusanone C and isosophoranone were effective to only gram positive bacteria, and broussochalcone A was effective to C. albicans. IC50 values of papyriflavonol A, kuraridin, sophoraflavanone D, sophoraisoflavanone A and broussochalcone A in HepG2 cells were 20.9, 37.8, 39.1, 22.1, and 22.0 microg/ml, respectively. These results support the use of prenylated flavonoids in Asian traditional medicine to treat microbial infection and indicate a high potential for prenylated flavonoids as antimicrobial agents as well as anti-inflammatory agents.

CD4-directed peptide vaccination augments an antitumor response, but efficacy is limited by the number of CD8+ T cell precursors

Peptide vaccination is an immunotherapeutic strategy being pursued as a method of enhancing Ag-specific antitumor responses. To date, most studies have focused on the use of MHC class I-restricted peptides, and have not shown a correlation between Ag-specific CD8(+) T cell expansion and the generation of protective immune responses. We investigated the effects of CD4-directed peptide vaccination on the ability of CD8(+) T cells to mount protective antitumor responses in the DUC18/CMS5 tumor model system. To accomplish this, we extended the amino acid sequence of the known MHC class I-restricted DUC18 rejection epitope from CMS5 to allow binding to MHC class II molecules. Immunization with this peptide (tumor-derived extracellular signal-regulated kinase-II (tERK-II)) induced Ag-specific CD4(+) T cell effector function, but did not directly prime CD8(+) T cells. Approximately 31% of BALB/c mice immunized with tERK-II were protected from subsequent tumor challenge in a CD40-dependent manner. Priming of endogenous CD8(+) T cells in immunized mice was detected only after CMS5 challenge. Heightened CD4(+) Th cell function in response to tERK II vaccination allowed a 12-fold reduction in the number of adoptively transferred CD8(+) DUC18 T cells needed to protect recipients against tumor challenge as compared with previous studies using unimmunized mice. Furthermore, tERK-II immunization led to a more rapid and transient expansion of transferred DUC18 T cells than was seen in unimmunized mice. These findings illustrate that CD4-directed peptide vaccination augments antitumor immunity, but that the number of tumor-specific precursor CD8(+) T cells will ultimately dictate the success of immunotherapy.

Usefulness of reversed display of soft-copy abdominal radiographs for urinary calculi detection

PURPOSE

To determine the usefulness of reversed display of soft-copy abdominal radiographs for urinary calculi detection.

MATERIAL AND METHODS

Sixty radiographs with a single urinary calculus less than 5 mm in the long diameter (15 in the kidney; 15 in the proximal ureter; 15 in the mid-ureter, 15 in the distal ureter) and 15 radiographs without calculi were evaluated. Four readers blinded to the presence or absence of urinary calculi on each radiograph reviewed the radiographs in the conventional display, reversed display, and combination of conventional and reversed displays at 1-week intervals. All images were evaluated in random order and the presence or absence of urinary calculi was interpreted using the confidence score from 1 to 5.

RESULTS

Multireader analysis for calculi in all locations showed a greater area under the receiver operating curve for combination of the two displays (0.764) than for the conventional display alone (0.655) (P=0.031). In the single-reader analysis for calculi in all locations, the third reader showed a greater area under the receiver operating curve for the reversed display (0.784) than for the conventional display (0.622) (P=0.027). Multireader analysis of the calculi in the kidney showed a greater area under the receiver operating curve for combination of the two displays (0.824) than for the conventional display alone (0.703) (P=0.043).

CONCLUSION

The reversed display of soft-copy abdominal radiographs may be useful for urinary calculi detection.